Abstract

Background

The measurement of healthcare provider performance is becoming more widespread. Physicians
have been guarded about performance measurement, in part because the methodology for
comparative measurement of care quality is underdeveloped. Comprehensive quality improvement
will require comprehensive measurement, implying the aggregation of multiple quality
metrics into composite indicators.

Objective

To present a conceptual framework to develop comprehensive, robust, and transparent
composite indicators of pediatric care quality, and to highlight aspects specific
to quality measurement in children.

Methods

We reviewed the scientific literature on composite indicator development, health systems,
and quality measurement in the pediatric healthcare setting. Frameworks were selected
for explicitness and applicability to a hospital-based measurement system.

Results

We synthesized various frameworks into a comprehensive model for the development of
composite indicators of quality of care. Among its key premises, the model proposes
identifying structural, process, and outcome metrics for each of the Institute of
Medicine's six domains of quality (safety, effectiveness, efficiency, patient-centeredness,
timeliness, and equity) and presents a step-by-step framework for embedding the quality
of care measurement model into composite indicator development.

Conclusions

The framework presented offers researchers an explicit path to composite indicator
development. Without a scientifically robust and comprehensive approach to measurement
of the quality of healthcare, performance measurement will ultimately fail to achieve
its quality improvement goals.